Attachment__5_-_Past_ _Present_Performance_Questionnaire_-_Dated_10_Apr_15.pdf

PAST AND PRESENT PERFORMANCE

QUESTIONNAIRE

FOR

SOLICITATION NO. FA5270-15-R-0003

Recyclable Material Collection & Processing

Okinawa, Japan

(10 Pages to include this cover page)

Dated: 10 Apr 15

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FA5270-15-R-0003

Past & Present Performance Questionnaire

PAST AND PRESENT PERFORMANCE QUESTIONAIRE

FOR

SOLICITATION NO. FA5270-15-R-0003

The government is placing increased emphasis in its acquisitions on “past or present performance” as a source selection evaluation factor. You have been provided as a reference in response to the subject solicitation for Recyclable Material Collection & Processing, Okinawa, Japan. In order for the government to evaluate the past performance of the firm providing you as a reference please provide frank, concise comments regarding your assessment of the contractor’s performance regarding this project. In accordance with FAR 15.306(e) (4), the name of individuals providing reference information about an offeror’s past performance shall not be disclosed.

Upon completion of this survey, please send it via e-mail to the address shown below no later than 4:00 pm, 10 Jul 2015 (Japan Standard Time).

18th Contracting Squadron/LGCA Attn: SSgt Marcus Tucker DSN Phone: 634-5834 Comm: 011-81-98-961-4109 Bldg. 99, Kadena AB, Okinawa E-mail address: Marcus.Tucker.1@us.af.mil

The individual knowledgeable of the contractor’s day-to-day operations and overall performance should complete this questionnaire. However, that individual is encouraged to supplement their own knowledge of the contractor’s performance with the judgment of others within their organization, as applicable.

In the event of inconsistency between English language and translation thereof into Japanese language, the English language meaning shall control.

If you have any questions concerning this survey, please call SSgt Marcus Tucker at 634-4109 (DSN), 011-81-98-961-4109 (Commercial), or e-mail. Your time and effort in providing this vitally important information are greatly appreciated.

Dated: 10 Apr 15

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PAST/PRESENT PERFORMANCE QUESTIONNAIRE

WHEN FILLED IN THIS DOCUMENT IS SOURCE SELECTION SENSITIVE INFORMATION IAW FAR 3.104

SECTION 1: CONTRACT IDENTIFICATION

A. Contractor: _____________________________________________________________

B. Cage Code of contractor contract was awarded to: _________________________________

C. Contract number: _______________________________________

D. Contract type: ______________________________

E. Was this a competitive contract? Yes _____ No _____

F. Period of performance: _________________________________________________________

G. Initial contract cost: $____________________________

H. Current/final contract cost: $_______________________________

I. Reasons for differences between initial contract cost and final contract costs:

J. Description of service provided:

SECTION 2: CUSTOMER OR AGENCY IDENTIFICATION

A. Customer or agency name: _________________________________________________________________＿＿＿

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract, i.e. local, nationwide, worldwide, other Commands:

SECTION 3: EVALUATOR IDENTIFICATION

A. Evaluator's name:

B. Evaluator's title:

C. Evaluator's phone/fax number: ___________________________________________________________________

Number of years evaluator worked on subject contract: _____________________

Dated: 10 Apr 15

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SECTION 4: EVALUATION

Please indicate your satisfaction with the contractor’s performance by placing an “X” in the appropriate block using the scale provided to the right of each question. This scale is defined as follows:

CODE PERFORMANCE LEVEL

E EXCEPTIONAL - The contractor’s performance meets contractual requirements and exceeds many (requirements) to the Government’s benefit. The contractual performance was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

VG VERY GOOD- The contractor’s performance meets contractual requirements and exceeds some (requirements) to the Government’s benefit. The contractual performance was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

S SATISFACTORY – The contractor’s performance meets contractual requirements. The contractual performance contained some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

M MARGINAL – Performance does not meet some contractual requirements. The contractual performance reflects a serious problem for which the contractor has not yet identified corrective actions or the contractor’s proposed actions appear only marginally effective or were not fully implemented.

U UNSATISFACTORY – Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

N NOT APPLICABLE - Unable to provide a score.

Dated: 10 Apr 15

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<Quality of Work>

1. Contractor’s ability to effectively control the quality of services provided.

契約請負業者はサービス内容の品質管理を効果的に行う能力を有していますか。

E VG S M U N/A

Comments (コメント・その理由など)

2. Contractor’s ability to meet appropriate staffing levels with sufficient number of qualified personnel with work ethic and customer service skills in order to provide required services. E VG S M U N/A

契約請負業者は要求されたサービスを提供するための十分な作業人員、かつモラルの

ある作業員を確保していますか。

Comments (コメント・その理由など)

3. The Contractor substantiated credible pricing data for change orders/modification?

契約請負業者は過去に契約に変更があった際に信憑性のある見積り等(変更に 伴う実支出内訳書)を提出しまし たか。

E VG S M U N/A

Comments (コメント・その理由など)

4. Was the contract partially or completely terminated for default or convenience?

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules).

過去に契約不履行や都合によって契約が一部、または全体的に解約と なった

経験がありますか？あればご説明下さい(費用が契約金以上に掛かった、不履行、納入計画に間に合わなかった等)

E VG S M U N/A

Comments (コメント)

5. Was the ordered service recycling collection?

契約請負業者に発注した業務はリサイクル回収業でしたか？ [ ] はい ［ ］いいえ

Comments (コメント)

6. The Contractor furnishes proper vehicles and crew members as ordered?

契約請負業者は発注通りに車両と作業員を手配できましたか? E VG S M U N/A

Dated: 10 Apr 15

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Comments (コメント・その理由など)

7. Were there any accidents/incidents?

事件、事故などが起きたことがありますか。

YES はい[ ] NO いいえ [ ]

Comments (コメント)

<Quality of Work>

8. Have you filed claims involving loss or damage?

損害によるクレームを申し立てたことがありますか？

YES

NO

YES (はい) Rate if the Contractor demonstrated a cooperative behavior.

申し立てをされた経験が有る場合、契約請負業者の対応を右の５段階で評価し

て下さい。

E

VG

S

M

U

If YES, records of claims? (はい)の場合、契約期間中申し立てたクレームの数は？ ( 件)

NO (いいえ) トラブルの経験無しの場合、N/A に○をつけてください。

<Timely Performance/Schedule>

9. Were there required performance time frames? What time frames were required, and did the Contractor meet them?

業務の作業開始・終了時間を指定していましたか。指定していた という場

合、どのような指定時間でしたか。また、その指定時間通り にサービスは提

供されましたか。

N/A

10. Contractor’s ability to meet specific response times and required time frames for providing the services.

契約請負業者は指定時間それにその時間内に業務を終えることができました

か？

Dated: 10 Apr 15

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11. Contractor’s timeliness in responding to emergency service requirements.

Contractor’s flexibility in satisfying the requirements of its customers.

契約請負業者は緊急のサービスが必要になったときに迅速に対応する能力があ

ると 思われますか。また顧客の要求に応じて臨機応変な対応をとることが出

来ますか。

12. Contractor’s responsiveness/timeliness for providing monthly reports/ documents/ submittals required by the contract.

契約請負業者は月例報告書や書類の提出に際して契約で要求されているとお りに 対処し、期限も守られていますか。

<Effectiveness of Management for Resolution of Issues/Problems/Customer Complaints>

13. Were key personnel knowledgeable about contractual requirements?

契約請負業者の現場監督者は契約内容について精通していますか。

14. Have you had any manning/staffing problems, such as, under manning, no-qualified personnel? And after recognizing the problems, the problems have been solved and contractor demonstrated a cooperative behavior?

人員不足や能力不足などによるトラブル(事故、不調和、不具合)がありました

か?それらの処理 においては協力的に問題解決がなされましたか。

YES NO

YES (はい) Rate if the Contractor demonstrated a cooperative behavior.

トラブルの経験有りの場合、契約請負業者は問題解決に協力的で あったかを 5 段階で評価下さい。

NO (いいえ) トラブルの経験無しの場合、N/A に○をつけてください。

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15. Provided timely resolution of contract discrepancies/problems. Contractor’s ability to correct problems and prevent or mitigate potential problems in a timely manner.

契約請負業者は契約に定められた職務を遂行する上で問題があった場合に迅速

に解決することが出来ている。かつ潜在的な問題を事前に予防したり軽減した

りする能力があると考えられますか。

16. If the company used subcontractors, how well did the company manage subcontractors?

契約請負業者が協力・下請け負い会社に業務を外注している場合、契約請負業

者による 協力・下請け負い会社に対しての管理はきちんと行われています

か

17. Does the company resolve issues, problems, customer complaints in a timely manner?

契約請負業者は契約や業務上の問題やクレームに対する対応を速やかに行って いま すか。

<Compliance with the Applicable Rules, Regs, Laws, including Safety Standards>

18. Contractor’s safety standards to meet the applicable Government policies, regulations, and contract requirements.

駐車違反なども含め、契約請負業者の提供するサービスの安全基準は該当する

法規と契約に則り対応できていますか。

19. Based on this contractor’s overall performance, would you hire this contractor again?

過去から現在における契約請負業者のサービス実績を総合的に判断して、貴社で はその契約請負業者を今後も取引継続したいと考えていらっしゃいますか。

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OVERALL RATING (総合評価) E VG S M U N/A

BASED ON THE ABOVE, WHAT IS YOUR OVERALL ASSESSMENT OF THE PRESENT/PAST PERFORMANCE

FOR THIS CONTRACTOR? AND WHY?

上記の評価に基づいて、契約請負業者に対する総合的評価をお答え下さい。

2. Please discuss each and every response for which you indicated as marginal or unsatisfactory in response to the questions above (use additional sheets, if necessary).

3. Government Contracts Only: Has/was this contract been partially or completely terminated for default or convenience or are there any pending terminations?

Yes___ Default ___ Convenience ＿＿ Pending Terminations ___

No ___

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules, etc).

SECTION 5: NARRATIVE SUMMARY

Would you have any reservations about soliciting this contractor in the future or having them perform one of your critical and demanding programs? Has election ever been made not to exercise a contract option or continue relations due to the contractor’s poor performance?

Dated: 10 Apr 15

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Overall Assessment E VG S M U N

What is your overall assessment of this past performance for this contractor?

Would you hire this contractor again? If not, explain.

Evaluator’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Email Address marcus.tucker.1@us.af.mil

Dated: 10 Apr 15

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FA5270-15-R-0003